Integumentary Physiology o Meissner's corpuscles

o Merkel's discs
OVERVIEW
o Ruffini corpuscles
- Integument = Skin L, a covering
Touch Processing
- Largest Organ of Human Body:
 Weighs about 8 pounds (3.6 kgs) - Processed in postcentral gyrus:
 Covers 22 sq feet  About top middle area of brain
 Contains 11 miles of blood vessels  Often referred to as primary
- Worldwide, dead skin accounts for about one somatosensory cortex
billion tons of atmospheric dust  More direct sensory input information
- Excretes up to 3 gallons of sweat on hot day than any other part of brain
FUNCTIONS OF SKIN Thermoregulation
 Protection (physical & immuno-regulation) - Skin is major organ controlling heat & moisture
 Contains Touch and pressure receptors flow to/from surrounding environment
 Thermoregulation - Skin also has thermal sensors:
 Secretion of Antibacterials & Synthesis of  Participate in thermoregulatory control
Vitamin D  Affect person’s thermal sensation &
 Excretion of metabolic wastes comfort
PROTECTION AGAINST… Heat Production
 Microorganisms - Most of body’s heat production is in:
 Chemicals  Liver
 Heat  Brain
 UV radiation  Heart
 Dehydration  Skeletal muscles during exercise
 Mechanical stresses - Human body is only 25% efficient
 Loses approximately 75% of energy as
Sense of Touch heat
- Touch is composed of various senses:
Regulating Body Temperature
 Somatic – sensations of temperature,
pressure, & pain - Heat is transferred:
 Kinesthetic – give conception of body in  Through network of blood vessels &
space (proprioception) tissue
 Visceral – such as stomach aches or  To skin
nausea - Heat exchange mechanisms include:
 Heat transfer at skin surface via:
Touch Sense o Conduction (sitting on cold
- In humans, about 90% of somatosensory cortex surface)
processes touch signals from hands & face o Convection (air temperature
- Touch senses in these areas is correspondingly colder than body)
sensitive/high-resolution o Radiation (long-wave and short-
- Palm can detect presence of fraction of gram wave)
 Via moisture evaporating/diffusing
Touch Receptors through skin
- Hairless skin (Glabrous) has finest receptors  Sweat evaporation on skin surface
 Mechanoreceptors translate physical  Respiration from lungs
force into nerve impulses Brain and Body Heat
 Four main mechanoreceptors in
hairless skin areas: - Brain is about 2% of body mass, BUT produces
o Pacinian corpuscles about 15% of body’s total metabolism:
  During high mental activity, this neuron - Integumentary system supports excretory system
metabolism can more than double in removal of waste
 Head has specialized - Skin provides for removal of:
thermoregulatory physiology:  Dead cells and sweat – contains waste
o Assures high rates of heat loss products
o Keeps brain temperature - Hair, fingernails & toenails
constant  Accumulations of dead epidermal cells
- As more cells die:
Thermoregulation  Need removal
- Core temperature regulated by brain’s  Hair & nails grow
hypothalamus (AKA body’s thermostat)
Waste in Sweat
- Hypothalamus responds to various temperature
receptors located thruout body - Sweat contains metabolic waste products—
- Makes physiological adjustments to maintain primarily:
constant core temperature  Sodium chloride
 Ex: On a hot day, temperature receptors  Urea
located in skin send signals to  Lactic acid
hypothalamus to increase sweat rate  Potassium ions
Sweat COMPONENTS OF INTEGUMENTARY SYSTEM
- Average person has 2.6 million sweat glands - Integument = average of 1 mm thick
- Sweat is made up of water & electrolytes such as  Epidermis
sodium, chloride,  Dermis
- and potassium  Hypodermis
- When hypothalamus senses increase in core - Accessory Tissues (Dermal Appendages):
temperature:  Sweat glands
 Increases blood flow to skin  Oil (sebaceous) glands
 Stimulates sweat glands  Hair
- Result – Increase in rate of water lost through  Nails
sweating
LAYERS OF SKIN
SECRETION OF ANTIMICROBIALS
 Epidermis
 The skin generates a number of antimicrobial  Five layers
 peptides/proteins (AMPs)  Keratin-producing cells
 Provide a front-line component in innate  Dermis (Cuteus)
immunity  True skin
 Inhibit microbial invasion  Hypodermis
 Subcutaneous layer of connective tissue
Synthesis of Vitamin D  Contains dermal appendages
- UV rays from sun strike skin  Nerves
- D from sun exposure, food, & supplements is  Blood vessels that supply dermis
biologically inert
Epidermis
- Must undergo 2 hydroxylations in body
- Liver converts D to 25-hydroxyvitamin D - About 0.012 cm thick
[25(OH)D], AKA calcidiol - Can thicken for greater protection:
- Kidney forms physiologically active 1,25-  Constant friction/pressure
dihydroxyvitamin D [1,25(OH)2D], AKA  Callus or Corn
calcitriol - Average turnover time for epidermis = ?
Excretion of Wastes Epidermis Strata
 Stratum Corneum
 - Outermost, Toughest layer of skin - 2 layers
- First defense against: - Papillary – L, papilla, nipple
 Microorganisms, UV, - Reticular – L, reticulum, little net
chemicals, heat  Having a netlike pattern or structure
- Flat, dead skin cells - Lymph vessels are in this layer
- Cells are cornified, filled with keratin
Papillary Layer
 Stratum Lucidum
- Clear layer holding substance: - Top layer of Dermis
 Becomes keratin as cells ascend - Fingerlike projections interface with Epidermis
 Pre-keratin = Eleidin - Give texture to surface (form rete pegs):
- Eleidin is found mostly in palms/soles  Loss of rete pegs with aging
 Thick skin  Skin gets thinner
 Stratum Granulosum  Skin gets smooth, shiny, paper-thin
- Flattened cells – No nuclei  Lose fingerprints
- Granular appearance
- Due to Keratohyalin Reticular Layer
 Also becomes Keratin - Main layer of Dermis
 Stratum Spinosum - Rest of connective tissue in Dermis
- AKA Squamous
- Larger layer Hypodermis
- Produces keratin for epidermis
- AKA Subcutaneous
- Spinous processes projecting between
- Layer of cushioning fat at base
adjacent, new Keratincytes
- Superficial fascia connecting dermis to muscle
 Stratum Basele
- AKA Germinativum Epidermal Cells
- Single layer
 Cuboidal and columnar cells - Four types of cells:
 Undergo mitosis  Keratinocytes (Gk, keras, horn)
 Keratinocytes divide  Melanocytes (Gk, melanin, black)
o Begin to move up  Langerhans cells
 Merkel cells
- Each one can have specific types of tumors
Keratinocytes
- Produce Keratin:
 Scleroprotein, main component of
 Hair, skin, nails
 tough and insoluable
 Hard, unmineralized structures on many
animals (scales, claws, horns, hooves,
feathers, shells)
- Divide and grow in lower epidermal layers, then
flatten, stack, and cornify as they ascend
- Kerartinization (Cornification)
 Outer epidermal layer is waterproof and
prevents dehydration
Melanocytes
- Produce Melanin:
 Pigment that colors skin and hair
Dermis
- AKA cuteus or corium
  Melanocytes in darker-skinned people - Contain/release chemical mediators (histamine,
are more active; same number of etc.) in response to triggers
melanocytes - Triggers vary & are individual:
 Moles, freckles, suntans  External OR Internal
 Protects the skin against UV radiation  Can vary from day to day
- Located in lowest level of epidermis - Set off a mast cell response:
 Antibiotics, foods, food additives
Langerhans Cells  Stress, fatigue, heat, cold, sunlight
- Paul Langerhans (1847 - 1888) German  Bacteria or fungi
pathologist, physiologist & biologist  Toxins, smells
- Migrate from bone marrow - When triggered
- Begin immune response against antigens due - Degranulate
to infection:  Release chemicals
 Similar to macrophages  All at once OR
- Located in stratum spinosum layer  Slow, leaky process

Merkel Cells Macrophages

- Friedrich S. Merkel, German anatomist - Gk, makros, large + phagein, to eat

 Described in 1875 - Ingest cellular debris, pathogens
- Function not completely understood: - Key role in immune response
 Light touch for hand dexterity - Help destroy tumor cells, invading
 Discrimination of shapes/structures microgranisms (bacteria, protozoa)
 Both sensory and hormonal functions - Type of WBC:
 Sometimes referred to as neuroendocrine  Derived from bone marrow
cells  Reside in tissue, monocytes migrate via
- Located in basal layer blood
 Become marcrophages in tissue
Dermal Cells - Integrates pathogen’s antigen into own cell
- 3 types of cells: membrane
 Fibroblasts - Presents to other immune cells, causes
 Mast cells - Creation of antibodies:
 Macrophages  Attach to antigen, destruction easier
- Each type has different function - Releases many types of chemicals:
 Enzymes
Fibroblasts  Complement proteins
 Interleukin regulators
- Synthesize extracellular matrix precursors:
- Stimulate lymphocytes
 Collagen
 Reticular and elastic fibers Hypodermal Cells
 Glycoproteins
- Determines properties of connective tissue - Mainly fat cells
- Structural framework of dermis; ability to move - Cushioning layer
- Main function: - Some fibroblasts & macrophages
 Maintain structural integrity of skin Skin Tissues
Mast cells - Each Layer of Skin has different tissues with
- AKA mastocyte or labrocyte different functions:
- In tissues with some interface to outside  Epithelial
- Also found in digestive and respiratory tracts  Collagen
- Do NOT circulate  Elastin
- Hypersensitivity reactions of skin  Reticulin
 Follicles
 Glandular
  Nervous  Cornified (dead) by time leaves
 Blood vessels surface
 Fatty tissue  Follicle = from matrix (bulb) in dermis
extending to surface at angle
Epidermis Tissue  Erector Pilus = muscle attached to
- Epithelial tissue only follicle
- Protects all exposed areas of body organs: - Protects and decreases heat loss
 Against Abrasion and injury
HAIR STRUCTURES
- Surfaces & lining of ducts/cavities
- Controls passage of material from outside into
organ’s cells
- Contains nerve fibers for sensory awareness
Dermis
- 3 types of fibrous connective tissues:
 Collagen
 Elastin
 Reticulin
- Strength, Firmness, Flexibility
- All arranged irregularly, haphazardly
- Allows skin to flex, stretch, contract when
stressed
Collagen
- One of most abundant proteins in body
- Firmness
- Connects and Supports body structures
Skin Muscles
- Immense tensile strength
- Arrector pili (sing.)
Elastin
- Contraction:
- Helps keep skin flexible, tight  Goose bumps/gooseflesh
- Ability to bounce back  AKA Horripilation or cutis anserina L
- Return to normal shape goose skin
 Caused by stimulus (cold or fear):
Reticulin  Causes nerve discharge from
- Protein fibers sympathetic nervous system,
- Crosslinked supportive meshwork for soft tissue part of ANS (involuntary)
 nerve discharge causes
Dermis Accessory Tissues contraction of arrectores pilorum
- Specialized Epithelial Tissues (Exocrine): (hair erectors)
 Sebaceous (Oil) glands - Benefits:
 Sudoriferous (Sweat) glands  Part of fight or flight reaction
- Hair follicles TYPES OF HAIR
- Nerves
1. Lanugo
Hair Structures - Soft downy hair covering fetus of some
- Tricho- Gk: hair [thread; filament; condition of mammals
the hair] 2. Vellus hairs
- Integrated with sebaceous glands: - Line hairs appearing after lanugo hairs
 Shaft = Hair above surface cast off
- Persist until puberty
 3. Terminal hairs - Transmit impulses to brain
- Coarse hair on various areas of adult
body Nerve Tissue

HAIR GROWTH CYCLE - Pacinian corpuscles

 Detect vibrations/heavy touch
3 Phases of the Life of a Hair: - Meissner’s corpuscles
 Detect light touch
1. Anagen (about ½ inch/month, about 5 years)
 Provide protection – painful/harmful
- 1st phase of hair cycle, in which
- Ruffini corpuscle
synthesis of hair occurs
 Specialized sensory nerve organs in skin
2. Catagen (2-3 weeks)
& mucous membranes for perceiving
- Transitional phase of hair cycle between
heat
growth and resting of follicle
- Krause corpuscle (end bulb)
3. Telogen  Bulboid encapsulated nerve endings
- Resting phase of follicle in hair cycle
located in mucous membranes and
Hair Cell Growth activated by cold
- Free nerve ending
- The cells of hair bulb divide every 23 to 72 hours,  Receptor nerve ending NOT enclosed in
faster than any other cell in body a capsule
- Chemotherapy and hair
Hypodermis Tissue
Gland tissue
- Connective tissue
- Sebum = oily substance  Connects overlying epidermis/dermis to
 Lipids underlying muscle
 Oils skin and hair - Dermal appendages
 Prevents drying/cracking  Hair, sweat and oil glands
 Limits growth of bacteria - Blood vessels
- Sweat - ANS nerves
 Watery, has salts - Fatty tissue
 Cools body, Role in thermoregulation
 Delivers metabolic waste to surface Skin and Aging

Sweat Glands - Epidermis thins, although number of cell layers

remains unchanged
- 2 main types of sudoriferous or sweat glands: - Number of melanocytes decreases
 Eccrine glands – palms, soles, forehead - Remaining melanocytes get larger
 Temperature control - Large pigmented spots (age spots, liver spots
 Apocrine glands – sweat, fats, proteins or lentigos)
 Slightly more viscous sweat  May appear in sun-exposed areas
(scent glands) - Elastosis or Solar elastosis
 Mainly present in armpits and  Skin's strength and elasticity is
around anogenital area ears, reduced:
hands, cheeks, navel, and  Changes in connective tissue
areolas strength & elasticity
- 2 other types of sudoriferous glands – produce - Leathery, weather-beaten appearance:
modified sweat:  Farmers
 Ceruminous glands – ear wax  Sailors
 Mammary glands – milk  Others:
Nervous tissue  Spend a large amount of time
outdoors
- Deep in dermis  Tanning beds
- Many different types of sensory receptors - More fragile Dermal Blood vessels:
- Perceive stimuli
  Bruising, bleeding under skin (often  Most proximal aspect of perionychium
called senile purpura), cherry angiomas,  Composed of dorsal roof & ventral floor
etc.  Found approximately 15 mm distal to
- Less oil produced by Sebaceous glands: DIP
 Men experience a minimal decrease  Dorsal roof rests above forming nail
 Usu. after 80  Houses cells that give shine to
- Women gradually produce less oil at menopause nail
- May make it harder to keep skin moist:  Ventral floor lies beneath nail
 Cause of dryness and itchiness  Immediately distal to insertion of
- Thinning of subcutaneous fat layer: extensor tendons
 Reduces normal insulation and padding  Site of germinal matrix
 Increases risk of skin injury  Responsible for 90% of nail
 Reduces ability to maintain body production
temperature  Eponychium
 Increases risk of hypothermia in cold  Skin proximal to nail that covers
weather nail fold
- Less sweat produced by sweat glands:  Cuticle
 Harder to keep cool  Tissue distal to eponychium in
 Increases risk for becoming overheated contact w/nail
- Thinning skin reduces:
 Ability to sense touch, pressure, Lunula
vibration, heat and cold - Half-moon shaped white arc
 Ability to repair itself:  Proximal to distal on nail
 Wound healing may be 4X - Distal extent of germinal matrix
slower - Characteristic color change:
 Higher risk of injury  Due to persistence of nail cell nuclei in
- Thinning skin increases: germinal matrix
 Risk of pressure ulcers - Distal to this location:
- MOST skin changes are related to SUN exposure  Nuclei absent
- PREVENTION is important throughout life  Nail transparent
NAILS Sterile Matrix
- Area of nail bed distal to lunula
- 2ndary site of nail production
- Tightly adherent to:
 Nail plate
 Periosteum of distal phalanx
Hyponychium
- Junction formed bet. sterile matrix & fingertip
skin beneath nail margin:
 Susceptible to contamination from
environmental interactions
 Keratin plug acts as mechanical barrier
- Nail plate
 Emerges from proximal nail fold, to protect against infectious
bordered either side by lateral nail folds inoculation:
 Has polymorphonuclear
(paronychium)
leukocytes & lymphocytes
 Hard, keratinized, squamous cells
 Contributing immunologic
loosely adherent to germinal matrix
barrier to mechanical barrier
 Strongly attached to sterile matrix
- Nail fold Nail Blood Supply
 - Perionychium Male Breast
 Arterial blood supply from terminal
branches of radial & ulnar proper palmar
(volar) digital arteries
 These originate proximal to
metacarpophalangeal joint from common
palmar digital arteries
- Proper palmar digital arteries
 Branch proximal to DIP joint
 Have branch that travels dorsal to DIP
joint
 Supplies superficial arcade that feeds nail
fold & proximal matrix
NAIL ANATOMY

Breast Anatomy
- Located in upper ventral region:
 Over pectoralis major muscles
 Extends from 2nd to 6th rib
 Superior lateral quadrant extends
diagonally upwards into axillary area:
Section of last bone of finger
 To Tail of Spence
- 5, Fat, forming the cushion at the end of the finger  AKA Spence's tail, axillary
- 2, The nail process, axillary tail
- 1, The cuticle continued under and around the  James Spence (1812-1882),
- 3 Root of the nail Scottish surgeon
 Thin layer of mammary tissue:
BREAST  From clavicle to 7th/8th rib
- ICD -9/10-CM – part of Reproductive System  From midline to edge of
Chapter latissimus dorsi posterior
- CPT – part of Surgery/Integumentary System Breast Quadrants
Section
Female Breast

- For clinical purposes, the breast is divided into

four quadrants
 - Upper inner - Mammary glands and milk:
- Upper outer (largest)  Milk at back of breast
- Lower inner  Suckling makes smooth muscles of
- Lower outer mammary glands to be pushed to ducts,
and then to nipple
Breast Tissue  15-25 openings in nipple
- Breast is a combination of:
Breast Lymph Nodes
 Lactiferous (milk-producing) ducts
 Connective tissue - Lymph travels from breast to:
 Adipose tissue  Ipsilateral axillary lymph nodes
 Cooper's ligaments  Parasternal nodes
 Help support the breast  Other breast lymph nodes
 Abdominal lymph nodes
Breast Anatomy
- Axillary lymph nodes
- Blood supply  Pectoral
 Internal thoracic (internal mammary)  Subcapsular
artery  Humeral
 Lateral thoracic, thoraco-acromial and - Central axillary, then to Apical axillary
posterior intercostals arteries
Breast Growth
- Blood drainage
 Axillary, internal thoroacic, & intercostal - Due to changing sex hormones (puberty):
veins  Estrogen
- Nerves - Pregnancy changes:
 Anterior/lateral cutaneous branches of 4th  Larger, firmer – hypertrophy of
- 6th intercostal nerves mammary glands
 Prolactin hormone
Breast Components  Nipples may enlarge, become darker
- Contains mammary glands: - Menstrual cycle
 Various sizes, distributed thru out breast  Also may cause breast/nipple changes
 Modified sweat glands
- Nipple and areola
- Connective tissue
- Adipose tissue
- Cooper ligaments
Nipple
- Nipple surrounded by areola:
 Drainage point for lactiferous ducts
 Each duct has own opening
 Large # of blood vessels
 Large # of nerves good luck! 
- Erection in response:
 Sexual stimuli - chu
 Cold
 Touch
 Enabled by nerve and blood supply
Areola
- Areola
 Varies in color – pink to dark brown
 Contains sebaceous glands